Journaling For Joy

IF YOU ARE MAILING THIS PAGE, PLEASE FOLLOW THESE INSTRUCTIONS:

Print out this page.

Number your responses to correspond with the questions.

Answer the following questions as completely as possible. Your answers should be honest and candid.

Your responses may be of any length and will be kept entirely confidential.

When you are ready to begin, return the completed application, with your signature at the bottom below the No. 14, along with a recent photograph:

Live Your Dream
PMB #111
826 Orange Ave.
Coronado, CA 92118-2698

Who are you? Please tell me everything I need to know to best meet your needs.

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Besides vital statistics, you may wish to include information on gender, marital status, birth date, education, occupation, any specialized training, licensing, degrees, special interests, or any of your past history you wish to share.
Which certification program are you interested in?
How did you become interested in this program? Would you describe yourself as being passionate about it? Why or why not? Please provide at least 5 reasons why you would like to participate in this program.
What is your present lifestyle? Does the training program you are interested in fit with your present lifestyle? If so, how? If not, what changes will you make and how will you make them?
What is your basic philosophy of life? How does your viewpoint match your training program interest?
Do you have a dream for yourself? If so, what is it and how do you expect to accomplish it? (Include as many dreams as you like.)
What is your history as a journal keeper? What have you learned and experienced from keeping a journal so far? Do you want to continue keeping a journal? Why or why not?
Are you presently counseling, consulting or coaching? If so, what is your area of expertise? What have you learned and experienced from your practice thus far? What do you want to do in your professional life in the future?
Have you had previous experience as a workshop facilitator? If so, on what topics? Who designed the curriculum? How does this previous experience relate to the Live Your Dream program(s) you have selected?
Do you have any concerns or fears about the certification training program itself, or about becoming a facilitator or coach? If so, please tell me about them.
What questions about your certification program do you have? Please do not limit yourself. I love answering questions, and will incorporate them into our curriculum when you are ready to begin.
What do you expect to accomplish once you have received your certification program in the area of your choice?
I understand being certified in any of the Live Your Dream programs does not qualify me to engage in therapy of any kind unless I have the training and credentials to do so.

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